The effects of green kiwifruit combined with isoflavones on equol production, bone turnover and gut microflora in healthy postmenopausal women

Abstract:Background and Objectives: Isoflavone (daidzein and genistein) interventions in postmenopausal women have produced inconsistent skeletal benefits, partly due to population heterogeneity in daidzein metabolism to equol by enteric bacteria. This study assessed changes in microflora and bone turnover in response to isoflavone and kiwifruit supplementation in New Zealand postmenopausal women. Methods and Study Design: Healthy women 1-10 years post-menopause were randomly allocated to group A (n=16) or B (n=17) for a 16-week crossover trial. Two consecutive 6-week treatment periods had a 2-week lead-in period at intervention commencement and a 2week washout period between treatments. Treatments prescribed either (1) daily isoflavone supplementation (50 mg/day aglycone daidzein and genistein) alone, or (2) with two green kiwifruit. At treatment baseline and endpoint (four time points) the serum bone markers C Telopeptide of Type I collagen (CTx), undercarboxylated osteocalcin (unOC), and serum and urinary daidzein and equol, were measured. Changes in gut microflora were monitored in a subgroup of the women. Results: Equol producers made up 30% of this study population (equol producers n=10; non-equol producers n=23) with serum equol rising significantly in equol producers. Serum ucOC decreased by 15.5% (p<0.05) after the kiwifruit and isoflavone treatment. There were no changes in serum CTx or in the diversity of the gut microflora. Conclusions: 50 mg/day isoflavones did not reduce bone resorption but kiwifruit and isoflavone consumption decreased serum ucOC levels, possibly due to vitamin K1 and/or other bioactive components of green kiwifruit.

Dietary patterns, dietary lead exposure and hypertension in the older Chinese population

Abstract:Background and Objectives: With rapid population ageing and an increasing rate of hypertension in China, this study aims to examine the association between dietary patterns, dietary lead and hypertension among older Chinese population. Methods and Study Design: We analysed the 2009 China Health and Nutrition Survey data (2 634 individuals with dietary and hypertension measurement data, aged ≥60 years). Dietary data were obtained using 24 hour-recall over three consecutive days. Dietary lead intake is based on a published systematic review of food lead concentration and dietary lead exposure in China. Factor analysis was used to identify dietary patterns. Poisson regression and multinomial logistic regression models were used to explore the association between dietary patterns and hypertension. Results: The prevalence of hypertension was 47.0% in men and 48.9% in women. Traditional dietary pattern (high intake of rice, pork and vegetables) was significantly inversely associated with known hypertension. In the fully adjusted model, compared with the lowest quartile of traditional dietary pattern, the highest quartile had a lower risk of known hypertension, with Relative Risk Ratio=0.69 (95% CI: 0.50; 0.95). However, associations between modern dietary pattern and hypertension differed by urbanization; an inverse, positive and null association was seen in low, medium and high urbanization. Additionally, dietary lead showed a significant positive association with hypertension and known hypertension. Conclusions: Policies that facilitate and promote healthy diets, and the availability of healthy foods particularly at the regional and local levels, are important for the prevention of hypertension.

Consumption and sources of added sugar in Thailand: a review

Author:Wantanee Kriengsinyos, Pauline Chan, Maria Sofia V Amarra

Keywords: sugar, processed foods, diet, Thailand, nutrient intake

Abstract:Background and Objectives: The present review examined the best available evidence regarding consumption levels and sources of added sugar in different population groups in Thailand. Methods and Study Design: Information was extracted from food balance sheets, household expenditure surveys, food consumption surveys, government reports, published and unpublished studies. Results: A total of 24 references were obtained, comprising 8 nationally representative reports and 16 individual studies. Results were inconsistent. The National Statistical Office reported an available supply of 83 g sugar per capita per day in 2010. The 2009 Food Consumption Survey of Thai Population showed median intake of sugar and sweeteners for all age groups ranging from 2.0 to 20.0 g per day among males and from 2.0 to 15.7 g per day among females (below the Thai recommendation of 40 to 55 g/day). Studies on children suggested intake levels between 25 to 50 g/day, while studies on adults were inconsistent. Frequently consumed sources were table sugar, sweetened beverages, and sweet snacks (traditional desserts, baked products, crispy snacks). Conclusions: Insufficient evidence exists regarding intake levels and sources of added sugar in Thailand. Limitations were the use of food frequency questionnaires or a single 24-h recall to assess intake, and outdated studies with small sample sizes. An updated nationally representative survey using improved methods is needed to determine the levels and sources of sugar intake in different population groups. These include biomarkers to establish levels of consumption and multiple 24-h recalls (at least two) to identify food sources that contribute significantly to excess sugar intake.

Selenium in infant formula milk

Abstract:Formula-based animal milk is an alternative source of infant nutrition in many cases when breastfeeding is unacceptable or inaccessible; however, these replacements often have low selenium levels. The composition of infant formula milk should be as close as possible to that of human breast milk, both in content and chemical speciation. Selenium is an essential trace element for infants. Generally, human breast milk is the ideal food to ensure adequate infant Se intake. However, to date, sodium selenite or sodium selenate has been used as selenium supplementation in infant formula milk in most countries. This inorganic Se, which is not a natural component of food, may not be the optimal speciation for Se supplementation in infant formula milk. Advances in speciation in foods, especially in animal milk, suggest that future proposals for selenium speciation in human breast milk can lead to discussions regarding the most favorable methods of selenium supplementation in infant formula milk.

Abstract:Background and Objectives: Malnutrition is an important prognostic factor for patients with liver disease and a novel nutritional assessment tool is required for these patients. The aim of this study was to validate the Mini Nutritional Assessment (MNA) as a nutritional screening tool for patients with liver disease, by comparing MNA scores with other nutrition-related parameters. Methods and Study Design: Patients who were hospitalized at the gastroenterology division of Kyushu and Beppu Medical Center were enrolled. The study included 77 patients with liver disease (male/female, 46/31; mean±SD age, 68.5±10.7 years; liver cirrhosis, 64.9%; liver cancer, 61.0%). Correlations of MNA score at hospital admission with anthropometric parameters and blood test data were evaluated. Results: In patients with liver disease, MNA scores demonstrated that 18 (23.4%) had normal nutritional status, 41 (53.2%) were at risk of malnutrition, and 18 (23.4%) were malnourished, indicating that up to 76.6% of the liver disease group were malnourished. Especially, patients with liver cirrhosis had lower scores of nutritional markers and MNA. The MNA score in liver cirrhotic patients correlated with the following parameters: % arm circumference, % triceps skinfolds, ratio of % maximum grasp strength and arm circumference, maximum grasp strength, arm muscle circumference, calf circumference, serum albumin levels, the controlling nutritional status score, and Onodera’s prognostic index, while patients without liver cirrhosis did not show such correlation. Conclusions: MNA scores correlated with nutrition-related data in patients with liver cirrhosis. The MNA is an appropriate tool for nutritional screening assessment in these cirrhotic patients of any etiology.

Abstract:Background and Objectives: To investigate the clinical outcomes in septic patients
receiving parenteral fish oil. Methods and Study Design: A prospective, non-randomized,
observational clinical study was carried out in 112 patients with sepsis from March, 2013 to
May, 2015 in the surgical intensive care unit (SICU) of a tertiary-referral hospital. The
patients were put into one of two groups; either the control or the study group. Patients
received the standard treatment of sepsis based on guidelines in the control group. In the
study group, patients received parenteral nutrition (PN) containing fish oil. The Acute
Physiology and Chronic Health Evaluation II (APACHE II) scores, the length of ICU and
hospital stay, duration of mechanical ventilation, mortality, and readmission into the ICU
were recorded. Tumor necrosis factor (TNF)-α and procalcitonin (PCT) levels were also
evaluated. Results: The study group showed a significant reduction for all-cause mortality
(20.0% vs 10.0% in study and control groups, p=0.034) and APACHE II score on day 5
(p=0.015), day 7 (p=0.036) and day out of SICU (p= 0.045) compared with the control group.
The study group tended to show a shortened length of stay in the ICU compared to the
control group. However, TNF-α and PCT level, 28 d mortality, the length of hospital stay and
the duration of mechanical ventilation did not show statistical differences between the two
groups. There were no drug-related adverse effects shown during the study. Conclusion: PN
with fish oil is probably safe and may improve clinical outcome in critical ill patients with
sepsis.

Abstract:Background and Objectives: The stoma of intermediate position enterostomy (IPE) often leads to high output, which is related to electrolyte abnormalities, and prolongs patient recovery post-operatively. The continuous nasogastric tube feeding method has the advantage of reducing the risk of feeding intolerance, and improves nutrient absorption. In the current study, we review our experience with continuous tube feeding and compare the clinical outcomes with intermittent oral feeding in patients with an IPE post-operatively. Methods and Study Design: This was a retrospective review of 118 infants with IPEs in our hospital. The infants were categorized into two groups (intermittent oral feeding [OF] group [n=68 infants, 1–14 days of age] and continuous tube feeding [TF] group [n=50 infants, 1–14 days of age]). Differences in stool volume, daily intravenous fluid infusion, weight gain, nutrition indices, and post-operative complications were reviewed. Results: The stool volume and intravenous fluid infusion in the TF group were less than the OF group from week 2. The weight gain was higher in the TF group than the OF group from week 3. The pre-albumin and retinol binding protein levels were significantly higher in the TF group than the OF group in weeks 3–4 post-operatively. The incidence of cholestasis and water-electrolyte disturbances in the TF group was significantly lower than the OF group, and the incidence of intestinal obstruction was lower than the control group, but the differences were not significant. Conclusions: Continuous tube feeding had better clinical outcomes than intermittent oral feeding in IPE patients.

Abstract:Background and Objectives: To investigate the nutritional status of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and the factors involved. Methods and Study Design: We used the Subjective Global Assessment (SGA) of nutritional status, a general questionnaire, dietary records, and laboratory parameters from 3 consecutive days to develop a NS assessment with it, we assessed 240 patients undergoing CAPD at a dialysis center in Henan Province. Results: In this setting, the prevalence of malnutrition in patients undergoing CAPD was 11.7%. Univariate analysis showed that patient characteristics related to NS included energy and protein intakes, weight and BMI, dialysis duration, urinary creatinine, and total creatinine clearance rate. Multiple linear regression analysis revealed that dialysis duration (p=0.00) and energy intake (p=0.01) were the principal predictors of nutritional status and allowed 81% of the variance in nutritional status to be explained. Conclusions: Effective collaboration between nutritionists and other health care workers to minimise dialysis duration and optimize energy intake should improve the nutritionallyrelated quality of life and well-being among CAPD patients.

Effects of eating frequency on respiratory quotient in
patients with liver cirrhosis: a randomized controlled
trial

Abstract:Background and Objectives: Respiratory quotient (RQ) is a good marker of substrate oxidation. Low RQ is frequently found in patients with liver cirrhosis and is associated with poor outcome. The purpose of this study was
to demonstrate the effects of eating frequency on RQ in patients with cirrhosis. Methods and Study Design: We
performed a randomized controlled trial to assess the effects of eating frequency on RQ in patients with cirrhosis.
Seventy patients and 30 healthy controls were enrolled, and patients were further randomized to receive either
normal eating frequency (NEF) meals at 08:00, 12:00 and 18:00 h, or high eating frequency (HEF) meals at 08:00,
10:00, 12:00, 15:00, 18:00 and 20:00 h. The two groups had equivalent energy intake. Fasting RQ was measured
at 07:30 h and daytime RQ was measured at 11:30 and 17:30 h. Disease severity was evaluated using the Child–
Turcotte–Pugh (CTP) classification. Results: Fasting RQ and daytime RQ were significantly lower in patients
with cirrhosis than in healthy controls. Patients in the HEF group had a higher RQ than patients in the NEF group
at three time points. In patients with CTP-A, no significant differences in daytime RQ were observed between the
two groups. However, in CTP-C patients, daytime RQ was significantly higher in the HEF group than in the NEF
group. Serum free fatty acid levels were significantly decreased and albumin was significantly increased after
HEF intervention. Conclusions: HEF strategy is effective in improvement of RQ and is beneficial to patients
with cirrhosis.

Abstract:Background and Objectives: Refeeding hypophosphataemia (RH) is characterized by an acute electrolyte derangement following nutrition therapy. Complications associated include heart failure, respiratory failure, paraesthesia, seizure and death. We aim to assess its incidence, risk factors, and outcome in our local intensive care unit
(ICU). Methods and Study Design: A prospective observational cohort study was conducted at the mixed medical-surgical of a tertiary ICU in Kuantan, Malaysia. The study was registered under the National Medical Research Register (NMRR-14-803-19813) and has received ethical approval. Inclusion criteria include adult admission longer than 48 hours who were started on enteral feeding. Chronic renal failure patients and those receiving
dialysis were excluded. RH was defined as plasma phosphate less than 0.65 mmol/L and a drop of more than 0.16
mmol/L following feeding. Results: A total of 109 patients were recruited, of which 44 (42.6%) had RH. Patients
with RH had higher SOFA score compared to those without (p=0.04). There were no differences in the APACHE
II and NUTRIC scores. Serum albumin was lower in those with RH (p=0.04). After refeeding, patients with RH
had lower serum phosphate, magnesium and albumin, and higher supplementation of phosphate, potassium and
calcium. There were no differences in mortality, length of hospital or ICU stay. Conclusions: Refeeding hypophosphataemia occurs in almost half of ICU admission. Risk factors for refeeding include high organ failure
score and low albumin. Refeeding was associated with imbalances in phosphate, magnesium, potassium and calcium. Future larger study may further investigate these risk factors and long-term outcomes.

Abstract:Background and Objectives: The aim of this study was to investigate (1) the hydrocolloid properties of grass jelly on reducing glycaemic response, (2) the impact of phenolic compounds in Mesona chinensis L. on glycaemic response. Methods and Study Design: A total of 15 healthy Chinese men were recruited to this study. On each visit, subjects consumed one of the following three treatments, i.e. glucose solution (T1), grass jelly (Mesona chinensis L.) solution with glucose (T2) or grass jelly gel with glucose (T3). Capillary blood glucose and venous plasma insulin were analysed over a period of 180 min. Results: The incremental area under the curve for capillary glucose and venous plasma insulin for glucose group, grass jelly solution group and grass jelly gel was found to be statistically not significant (p>0.05). In a previous study the co-ingestion of grass jelly with complex carbohydrate was found to reduce glycaemic response. The key difference between the two studies was the use of monosaccharide glucose in the present study, compared to complex carbohydrates in the other. The present study suggests that the glycaemic lowering effect of grass jelly may be dependent on the inhibition of carbohydrase enzymes. Conclusions: The co-ingestion of Mesona chinensis L. appears to reduce glycaemic response of only complex carbohydrates through the inhibition of carbohydrase. This conclusion was arrived at by the lack of any effect of Mesona chinensis L. on the monosaccharide glucose.

Regular egg consumption at breakfast by Japanese woman university students improves daily nutrient intakes: open-labeled observations

Abstract:Background and Objectives: Eggs, an important source of high-quality protein, contain a variety of key nutrients and antioxidants. Here we conducted an intervention study to evaluate whether the additional consumption of one egg per day would affect the daily nutritional intakes and blood antioxidant status in Japanese woman university students. Methods and Study Design: For 4 weeks, the 14 subjects were provided a nutritious breakfast including one boiled egg, and they were asked to keep a daily dietary record. Results: The subjects’ daily energy intake during the intervention did not differ compared to the baseline, whereas the protein energy ratio and cholesterol intake were significantly increased. The subjects’ consumption of confectionery during the intervention was significantly decreased compared to the pre-trial period. The total score of adherence to the food-based Japanese dietary guidelines for a healthy diet during the intervention was higher than that at baseline. The analysis of fasting blood samples showed that the subjects’ serum lipids levels were not altered, whereas their malondialdehyde modified low-density lipoprotein (MDA-LDL) levels and the oxidative susceptibility of LDL were significantly reduced after the intervention. More importantly, serum folic acid levels were significantly increased. Conclusions: Our results suggest that regular egg consumption at breakfast can help improve the daily nutritional status and dietary habits and also ameliorate certain indices of antioxidant status in young women.

Abstract:Background and Objectives: Western dietary patterns have been linked with kidney disease.
This study investigated the association between Chinese dietary patterns and kidney disease in a
Taiwanese population with type 2 diabetes and evaluated dietary fatty acid patterns, a
kidney-related dietary biomarker. Methods and Study Design: We recruited 838 patients with
type 2 diabetes and used their dietary and renal data obtained from three repeated measures in
2008, 2009 and 2010. Diet was assessed using food-frequency questionnaires, and factor analysis
was performed to identify dietary patterns. Albuminuria was defined by having an
albumin-to-creatinine ratio 30 mg/g and kidney dysfunction by estimated glomerular filtration
rate <60 mL/min/1.73m2. Generalized estimating equation models were used to estimate ORs (95%
CIs) of kidney disease adjusted for covariates. Erythrocyte fatty acids were only measured in
blood samples collected in 2008. Results: Three dietary patterns were identified: high fat-meat,
traditional Chinese food-snack, and fish-vegetable. In the adjusted model, the high fat-meat and
traditional Chinese food-snack diets were not associated with any kidney outcomes. The
fish-vegetable diet was inversely associated with kidney dysfunction (quartile 4 vs 1, OR: 0.75,
0.58-0.97), but not associated with albuminuria. A higher fish-vegetable diet factor score was
associated with higher n-3 fatty acid intakes. Conclusion: In patients with diabetes, we found
greater adherence to a fish-vegetable diet to be associated with better kidney function and greater
n-3 fatty acid profiles. The inclusion of repeated dietary assessments and dietary biomarker
measurements in future diet-disease research, especially in patient populations, may provide more
definitive risk evaluation.

Abstract:Background and Objectives: Large-scale epidemiological investigations worldwide have
shown that dietary glycemic load is associated with several metabolic diseases, including
diabetes. However, only a few studies have examined the correlations between dietary
glycemic load and blood glucose and lipid concentrations in Chinese patients with diabetes.
Therefore, this study aimed to determine these correlations in patients with newly
diagnosed type 2 diabetes in southeastern China. Methods and Study Design: 201
patients with newly diagnosed type 2 diabetes and 126 participants with normal blood
glucose concentrations were enrolled at the Sun Yat-sen University, Sun Yat-sen Memorial
Hospital, Guangdong Province. Carbohydrate intake and glycemic load were assessed
based on 3-day dietary records. Using glycemic load as the dependent variable, a
correlation analysis and multiple regression analyses were used to analyze the correlations
between dietary glycemic load and blood glucose and lipid concentrations. Results: The
mean dietary glycemic load in patients with newly diagnosed type 2 diabetes was
significantly higher than that in participants with normal blood glucose concentrations
(p<0.05). The correlation analysis showed that dietary glycemic load was positively
correlated with body mass index and glycated hemoglobin in patients with diabetes
(p<0.05) but negatively correlated with high-density lipoprotein cholesterol in both the
control and diabetes groups (p<0.05). Multivariable regression analysis indicated that,
among participants in southeastern China, a higher glycemic load increased the odds of
having diabetes, a low high-density lipoprotein cholesterol concentration, and higher
Charlson weighted index of comorbidities score, as well as being overweight. Conclusion:
A high-glycemic load diet may be associated with a risk of diabetes, glycemic control,
lipid metabolism, prognosis of diseases, and body composition. It is necessary to control
dietary glycemic load for both patients with diabetes and healthy people in southeastern
China.

Abstract:Background and Objectives: This study explored the prevalence of gestational diabetes mellitus (GDM) in Chinese pregnant women and identified risk factors for GDM after the implementation of the universal two-child policy. Methods and Study Design: On the basis of income and population, we randomly selected three hospitals through stratified and cluster sampling. From January 1 to July 31, 2016, 4959 women who had been registered within 12 weeks of gestation received a 75-g 2-h oral glucose tolerance test (OGTT) at 24–28 gestational weeks. International Association of Diabetes and Pregnancy Study Group criteria were used for the diagnosis of GDM. Results: The OGTT was positive in 1080 (21.8%; 1080/4959) women, who were then diagnosed as having GDM on the basis of their results. GDM was positively associated with the following factors: advanced maternal age (p<0.001; adjusted odds ratio [OR]=4.878; 95% confidence interval [CI]=2.379–10.000), pre-pregnancy body mass index overweight (OR=2.441, 95% CI=1.782–3.344)/obesity (OR=10.846, 95% CI=6.003–19.597; p<0.001), paternal history of diabetes (p=0.003; OR=2.543, 95% CI=1.383–4.674), and maternal history of diabetes (p<0.001; OR=3.598, 95% CI=2.163– 5.984). Conclusions: Qingdao has an exceptionally high estimated prevalence of GDM. Widely recognized risk factors for GDM were advanced age, pre-pregnancy overweight/obesity, and a family history of diabetes in first-degree relatives. More options to prevent and manage GDM must be explored.

Differences in brain-derived neurotrophic factor between neonates born to mothers with normal and low ferritin

Abstract:Background and Objectives: Maternal iron deficiency in late pregnancy, labor, and the postpartum period has an indirect impact to decrease neurotrophin concentration in the fetal hippocampus, namely brain-derived neurotrophic factor (BDNF). It plays an important role in the development of learning, memory, and behavior. The aim of this study was to determine the differences in BDNF between neonates born to mothers with normal and low ferritin. Methods and Study Design: This was an observational study with a cross-sectional design involving 20 term pregnant women with normal ferritin (≥12 ng/mL) and 20 term pregnant women with low ferritin (<12 ng/mL). Samples were taken from Yarsi hospital, BMC hospital, and Hardi clinic located in Padang, from August 2015 to February 2016. Umbilical cord plasma was examined directly after delivery using an enzyme-linked immunosorbent assay (ELISA) employed at the Biomedical Laboratory of Andalas University. Mean differences were statistically assessed by independent samples t-test. Results: Plasma BDNF concentrations in neonates born to mothers with normal and low ferritin were 3.81±1.37 ng/mL and 2.78±1.19 ng/mL, respectively (p=0.015). Conclusions: Plasma BDNF was lower in neonates born to mothers with low serum ferritin.

Breast milk and infant iodine status during the first 12 weeks of
lactation in Tianjin City, China

Abstract:Background and Objectives: The present study investigated the iodine status of breast
milk and breast-fed infants during the first 12 weeks postpartum in Tianjin, China.
Methods and Study Design: A total of 175 pregnant women were recruited before
delivery. Their breast milk and 24-h urine samples were collected at 4, 8, and 12 weeks
postpartum; spot urine samples were simultaneously collected from their infants. The
iodine content of the samples was measured. Results: The mean breast milk iodine
concentrations (BMICs) at 4, 8, and 12 weeks were 221.7±103.5 μg/L, 175.2±76.2 μg/L,
and 148.1±66.2 μg/L, respectively. Significant differences existed between the mean
BMICs of the three sampling times (F=12.449, p<0.001). The BMIC showed a decreasing
trend during the first 12 weeks postpartum. The median urinary iodine concentrations
(UICs) of the mothers were 152, 112, and 109 μg/L at the different sampling times. The
BMIC and UIC were not correlated in the mothers. The median UICs in the infants were
251, 183, and 164 μg/L. The infant UICs were statistically different at the three sampling
times (p=0.001). Moreover, the infant UICs correlated with the BMICs (Rs=0.205,
p=0.010) but not with the maternal UICs (Rs=0.131, p=0.067). Conclusion: The BMIC in
and infant iodine intake from breast milk decreased in the first 12 weeks. Breastfed infants
could receive adequate iodine from breast milk in Tianjin City.

Childhood overweight and obesity amongst primary
school children in Hai Phong City, Vietnam

Abstract:Background and Objectives: Childhood obesity is a rising health concern in Vietnam, however, research in this
area is not extensive. The aim of this study was to determine the prevalence of childhood overweight and obesity,
and to study associations between weight status and selected lifestyle factors, such as diet and physical activity
levels, among children aged 6-10 years in Hai Phong City, Vietnam. Methods and Study Design: Two hundred
and seventy-six children from an urban and a rural primary school participated in this cross-sectional study. Data
on weight, height and waist circumference were used to calculate BMI, and waist-height ratio to determine the
proportion of children who were overweight, obese and had high central adiposity. Information on diet, physical
activity and socioeconomic status of families was collected using questionnaires. Results: Prevalences of overweight, obesity and high abdominal adiposity were 11.2%, 10.1% and 19.9%, respectively. Children who completed 60 minutes of physical activity daily were 50% and 80% less likely to be overweight and have high abdominal adiposity, respectively. Computer usage increased the odds of overweight and high abdominal adiposity
by 4.5 and 3.9 times, respectively. Mothers with higher education and income levels increased the risk of their
children being overweight (p<0.05). Conclusions: Physical inactivity and high maternal education and income
levels increased the risk of childhood overweight and obesity in this cohort. Future interventions should target
parents and their children by providing both with educational modules centred on healthy eating habits, parental
feeding practices and strategies for increasing physical activity.

Abstract:Background and Objectives: This study aimed to determine the relationship between
breakfast consumption and body weight status among primary and secondary school
children in Malaysia. Methods and Study Design: This nationwide cross-sectional study
involved 5,332 primary school children aged 6 to 12 years and 3,000 secondary school
children aged 13 to 17 years. Height and weight were measured and BMI-for-age was
determined. Socio-demographic backgrounds, breakfast habits and physical activity levels
were assessed using questionnaires. Breakfast frequency was defined as follows: breakfast
skippers (ate breakfast 0-2 days/week), irregular breakfast eaters (ate breakfast 3-4
days/week) and regular breakfast eaters (ate breakfast ≥5 days/week). Results: The overall
prevalence of breakfast skippers and irregular breakfast eaters was 11.7% and 12.7%
respectively. Breakfast skipping was related to age, sex, ethnicity, income and physical
activity level. Among primary school boys and secondary school girls, the proportion of
overweight/obesity was higher among breakfast skippers (boys: 43.9%, girls: 30.5%) than
regular breakfast eaters (boys: 31.2%, girls: 22.7%). Among primary school children, only
boys who skipped breakfast had a higher mean BMI-for-age z-score than regular breakfast
eaters. Among secondary school boys and girls, BMI-for-age z-score was higher among
breakfast skippers than regular breakfast eaters. Compared to regular breakfast eaters,
primary school boys who skipped breakfast were 1.71 times (95% CI=1.26-2.32, p=0.001)
more likely to be overweight/obese, while the risk was lower in primary school girls
(OR=1.36, 95% CI=1.02-1.81, p=0.039) and secondary school girls (OR=1.38, 95%
CI=1.01-1.90, p=0.044). Conclusion: Regular breakfast consumption was associated with
a healthier body weight status and is a dietary behaviour which should be encouraged.

Intake ratio and major food sources of n-3 and n-6 fatty acids in
Korea: a study based on the sixth Korea national health and
nutrition examination survey (2013–2014)

Abstract:Background and Objectives: In addition to the intake ratio of omega 6 (n-6) to omega 3 (n-3)
fatty acids, their intake amount has an effect on health. This study evaluated the n-6:n-3 intake
ratio as well as the food sources and association of these fatty acids with demographic
characteristics based on sixth Korea National Health and Nutrition Examination Survey data.
Methods and Study Design: This study included 13,937 participants from the survey. The
weighted mean intake and major food groups of n-3 and n-6 fatty acids were determined. The 10
chief food sources of each n-3 and n-6 fatty acid were expressed as percent contribution to total
intake. Results: α-Linolenic acid constituted approximately 80% of total n-3 intake, followed
by docosahexaenoic acid (10.5%) and eicosapentaenoic acid (6.1%). Linoleic acid constituted 97%
of total n-6 intake. After adjustment for cofactors (age, sex, and energy intake), education level
(p<0.01), alcohol consumption frequency (p<0.05) and monthly income (p<0.01) were significant
variables determining n-3 and n-6 FA intake by Korean people. The average n-6:n-3 intake ratio
was 7.49:1. The major source of α-linolenic acid and linolenic acid was soybean oil, whereas that
of docosahexaenoic acid and eicosapentaenoic acid was mackerel. Pork (70.0%) and egg (38.7%)
were the major food sources of arachidonic acid and dihomo-γ-linolenic acid, respectively.
Conclusion: Monthly income, alcohol consumption frequency, and education level significantly
affected n-3 FA intake. The dietary n-6: n-3 intake ratio in Korea is high (7.49:1); however,
eicosapentaenoic acid and docosahexaenoic acid intake remains inadequate (0.27 g/day).

Prevalence and characteristics of misreporting of energy intake in Japanese adults: the 2012 National Health and Nutrition Survey

Abstract:Background and Objectives: Information on a whole array of characteristics associated with dietary misreporting in a representative sample in each country is still limited. Using data from the 2012 National Health and Nutrition Survey, Japan, we investigated the prevalence and characteristics of under- and over-reporting of energy intake among 19986 Japanese adults aged ≥20 years. Methods and Study Design: Each individual’s energy intake was calculated based on a 1-day semi-weighed dietary record. Under-, plausible, and over-reporters were identified based on the 95% confidence limits 1) for agreement between the ratio of energy intake to basal metabolic rate and a physical activity level for sedentary lifestyle (1.55), and 2) of the expected ratio of energy intake to estimated energy requirement of 1.0, assuming ‘low active’ level of physical activity. Results: Almost all subjects (92.8%) were classified as plausible reporters by any of the methods applied, with very low percentages of under- and over-reporters (6.3% and 2.0%, respectively). Under-reporting was associated with younger age, overweight and obesity (compared with normal weight), current smoking (compared with never smoking), no drinking (compared with drinking everyday), and household consisting of a single person (compared with that consisting of two persons). Over-reporting was associated with gender (female), normal weight (compared with overweight), and household consisting of a single person. Conclusions: Overall mean energy intake obtained in this sample of Japanese adults appears to be plausible, but caution should be exercised when assessing the plausibility of energy intake in some subgroups.

Abstract:Background and Objectives: Despite the demonstrated protective effects of green tea and coffee intake against several chronic diseases, finding between studies have not been consistent. One potential reason of this discrepancy is the imprecision in the measurement of tea or coffee consumption using food frequency questionnaire (FFQ) and food record (FR) in epidemiological studies. Methods and Study Design: In a sample of 57 healthy Japanese women, intake of green tea and coffee was estimated by a validated FFQ and a 3-day FR, while their plasma and urine concentrations of polyphenol biomarkers were measured by HPLC. The polyphenols assessed included (-)-epigallocatechin gallate (EGCG), (-)epicatechin gallate (ECG), (-)-epigallocatechin (EGC) and (-)-epicatechin (EC), caffeic acid (CA) and chlorogenic acid (CGA). Results: Green tea consumption estimated by FFQ and FR showed moderate association, while strong association was detected for coffee consumption. Urinary green tea polyphenol concentrations were moderately-strongly associated with FRestimated intake, while the associations were weak with FFQ. Similarly, coffee polyphenols in urine were moderately associated with FR-estimated coffee intake, whereas FFQ showed poor correlation. The associations between urinary and plasma polyphenols ranged from moderate to high. Conclusions: The results indicated that firstly, the FFQ tends to overestimate green tea intake. Secondly, the urinary polyphenols are preferred over plasma polyphenols as a potential surrogate marker of the short-term green tea and coffee intake, while their use as an indicator of long-term consumption is not reliable.

Taste perception and diet in people of Chinese ancestry

Abstract:Background and Objectives: Taste perception plays a key role in consumer acceptance and
food choice, which has an important impact on human health. Our aim was to examine the
relationship between taste intensities and preferences of sweet (sucrose), salty (sodium chloride
and potassium chloride), sour (citric acid), and bitter (quinine and phenylthiocarbamide) in
relation to dietary intake and dietary patterns in people of Chinese ancestry. Population and
Methods: This cross-sectional study included 100 adult Singaporean Chinese (50 women). A
validated taste methodology was used with taste solutions provided by Monell Chemical Senses
Center. Dietary intake and patterns were assessed by dietary recalls. Results: There was little
relationship between taste intensity and tastant preference in regard to background dietary intake
or pattern. Tastant differentiation was reliable, but there was some confusion in regard to the
rating of saltiness as sourness. Conclusion: There was a salty-sour confusion among Singaporean
Chinese unlike the bitter-sour confusion reported for Caucasians. Most sodium came from sauces
and was added during food preparation. In programs to address sodium: potassium ratio excess
among Chinese prone to hypertension and stroke, sour as well as salty taste may need to be
considered.

Ambient temperature-related exaggerated post-prandial
insulin response in a young athlete: a case report and
implications for climate change

Abstract:The objective is to present the case of a 21-yr-old athlete observed with non-physiological
immediate post-prandial insulin response (1162 pmol/l; normal glucose excursion: 6.6
mmol/l), in a warm environment. No suspicion or evidence of any underlying pathology
was found in this well-trained Afro-Caribbean male runner. He never reported any
hypoglycemic episode. When performing the same protocol performed in a cooler
environment (21.0°C vs 30.3°C), only physiological responses were observed. We
conclude that 1) youth, leanness and regular exercise training are not absolutely protective
against glucose metabolism impairment in apparently healthy subjects; 2) ambient
temperature should be regarded as a potential source of glucose metabolism impairment.

Dietary patterns and obesity in preschool children in Australia: a cross-sectional study

Abstract:Background and Objectives: Dietary patterns have been linked to the risk of obesity in adults but little is known about such a link in young children. To examine the association between dietary patterns, nutrient intake and obesity in a representative population of preschool children in Australia. Methods and Study Design: Dietary intake was assessed using a 3-day weighed food diary. Dietary patterns were identified by factor analysis. Children were classified as overweight or obesity if their BMI z-score was between the 85th – 95th percentiles or was above the 95th percentile, respectively. Results: Three dietary patterns were identified. The ‘Traditional’ pattern was characterised by grains, fruit, vegetables, and red meat. The ‘Processed’ pattern was characterised by processed meats, snack foods and confectionary. The ‘Health conscious’ pattern was characterised by eggs, fish, polyunsaturated margarines and low fat dairy products. The “Traditional’ pattern was positively associated with protein and zinc intake while the ‘Processed’ pattern was inversely associated. Both patterns were inversely associated with calcium intake. No associations were found between the ‘Health conscious’ pattern and macronutrients and key micronutrients intakes. The ‘Traditional’ pattern was positively associated with obesity but the association became non-significant after adjustment for energy and protein intake. No association was observed between the other two dietary patterns and weight status. Conclusions: In this cross-sectional study, dietary patterns were not associated with obesity. Longitudinal follow up will help to better understand the relationship between dietary patterns in early childhood and the risk of obesity later in life.

Factors which may limit the value of dietary diversity and its association with nutritional outcomes in preschool children in high burden districts of India

Abstract:Background and Objectives: Dietary diversity plays a critical role in infants as they need energy and nutrient dense foods for both physical and mental development. This study examines whether three dietary diversity indices validate against Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) and studies the relationship of dietary diversity with nutritional status of preschool children, in two districts of India: Wardha, Maharashtra and Koraput, Odisha. Methods and Study Design: Dietary diversity was calculated using: Individual food scores calculated using 24 hours diet recall (FS24hr) data; household dietary diversity using Berry’s index (DDI) and food scores calculated using food frequency data (FSFFQ). Nutritional status was assessed by anthropometric indices. Results: It was observed that 42.7% of 1 to 5 years children were underweight, 38% stunted and 27.6% wasted across both locations. The dietary diversity was found to be relatively better in Wardha when compared with Koraput with mean diversity of FS24hr 7, DDI 90 and FSFFQ 63 in both locations. Preschool children in both locations consumed a cereal based diet. Apart from protein in both locations and energy in Koraput, the NAR of all nutrients consumed was <70% of requirement. MAR showed lower consumption of nutrients than the recommended levels (50% adequacy). NAR and MAR correlate with FS24hr indicating that dietary diversity calculated using 24 hour diet recall ensures nutrient adequacy but showed association only with Height-for-Age scores. Conclusions: Dietary diversity calculated using three methods did not show any correlation with nutritional status of 1 to 5 years children.

Role of behavioural feedback in nutrition education for enhancing nutrition knowledge and improving nutritional behaviour among adolescents

Abstract:Background and Objectives: The integration of nutrition knowledge into nutritional behaviour can help children to develop a healthy lifestyle that may be carried forward into adulthood. E-learning enables students to take ownership of recording their dietary intake and modify their diets by making their own decisions regarding food choices and portion sizes through reflective feedback. This study investigated the role of behavioural feedback in nutrition education in modifying students’ nutrition knowledge and behaviour. Methods and Study Design: Ninety-five secondary students studying from Secondary 1 to Secondary 3 were recruited from five schools. Moreover, 50 and 45 students were randomly assigned to experimental and control groups, respectively. Nutrition education delivered through elearning (NeL) was adopted to record students’ diets. Online reports with behavioural feedback were provided for the experimental group but not for the control group. NeL sessions lasted for 12 weeks. The energy and nutrient profiles of the students were recorded as pre–post measurements. Pre–post nutrition knowledge was assessed using a self-administered questionnaire at the baseline and after intervention. Results: The experimental group had significantly higher scores in the ‘dietary recommendation’ and ‘food choices’ domains of the questionnaire and demonstrated significant dietary improvement in the intake of all studied macronutrients and micronutrients. Conclusions: Nutrition education conducted with behavioural feedback can effectively improve adolescents’ nutrition knowledge and nutritional behaviour

Nutritional quality and patterns of lunch menus at child care
centers in South Korea and Japan

Abstract:Background and Objectives: This study aimed to investigate the nutritional quality and
patterns of lunch menus provided by child care centers in South Korea and Japan. Methods
and Study Design: The weekly lunch menus from Monday to Saturday that child care
centers provided in November 2014 in South Korea and Japan were analyzed. For Korea, a
total of 72 meals provided by 12 centers in Seoul were analyzed by referring to the homepage
of the Center for Children’s Foodservice Management, which services menus for child care
centers. For Japan, a total of 30 meals provided by 5 child care centers in Tokyo were
analyzed. Nutrient content and pattern in lunch menus were evaluated. Results: The lunch
menus in Korea and Japan provided 359.5 kcal (25.7% of the estimated energy requirement)
and 376.3 kcal (29.5% of the estimated energy requirement), respectively. ‘Rice + Soup +
Main dish + Side dish I + Side dish II’ were provided in 72.2% of meals in Korea, while
various patterns with rice and soup as their bases were provided in Japan. Conclusion: The
lunch menus of child care centers in Korea and Japan provide similar amounts of energy,
protein, carbohydrate, vitamin A, calcium, and other nutrients. However, there were
significant differences in the lunch menu patterns in Korea and Japan. This study provides
information about the nutritional content and pattern of lunch menus at child care centers in
Asian countries with rice as a staple food.